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Selasa, 17 Desember 2013

Defining Iron-Deficiency Anemia in Public Health Terms: A Time for Reflection1,2


  1. Rebecca J. Stoltzfus
+ Author Affiliations
  1. Center for Human Nutrition, Department of International Health, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore MD

Abstract

This paper provides a historical context for this meeting, which aimed to examine critically the way we have defined iron-deficiency anemia as a public health problem. The terms and concepts used to define the problem are reviewed first, followed by estimates of the global prevalence of the problem from 1985 to 2000. It is argued that recent estimates are not credible and that we must redefine the problem in terms that are important, measurable and addressable. This meeting was designed to take first steps toward that goal, namely, to identify the causal factors (e.g., iron deficiency vs. iron-deficiency anemia vs. severe anemia from any cause) that link iron-deficiency anemia to important health outcomes and to estimate the magnitude of their effects in public health terms.
The impetus for this meeting was the conviction that we must define the problem of iron-deficiency anemia in terms of its health consequences in human populations. To do this with clarity, we must look critically at the evidence. First, this meeting must be put in historical context. Where have we come from in defining iron-deficiency anemia as a public health problem? Where do we hope to go?

WHERE HAVE WE COME FROM? TERMS AND CONCEPTS

The initial term and concept was nutritional anemias. Although this term is not commonly used today, it lives on in the name of the International Nutritional Anemia Consultative Group (INACG).3 Nutritional anemia was defined in a 1968 WHO technical report as “a condition in which the hemoglobin content of the blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless of the cause of such deficiency.”
To determine which nutritional deficiencies were most responsible, WHO coordinated a series of studies in pregnant women in which anemia, serum folate, transferrin saturation and serum B-12 were assessed. They concluded that “Iron deficiency was present in 40–99% of the pregnant women studied and was undoubtedly responsible for the major proportion of anemia” (WHO 1968). 

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